Identity verification helps to make sure that conversations between you and your users are kept private and that one user can't impersonate another. We strongly encourage all Intercom customers to set up and enable identity verification.

How does identity verification work?

The purpose of identity verification is to verify that your users are who they claim to be. It works by using a server side generated
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, using SHA256, on either your user’s email or user_id. Once identity verification is enabled, Intercom will not accept any requests for a logged-in user without a valid HMAC.

With identity verification, Intercom will sign all requests going to the Intercom servers with tokens. It requires your mobile application to have its own server which authenticates the app's users, and which can store a secret.

Of course, you can still enable identity verification later, but you will have to ensure that Intercom won't break for existing clients. As we will describe below, once you activate identity verification for an app, the server has to reject all requests (from clients running an older version of your app) that are not verified.

Don't worry, even once you've released the identity verification enabled version of your app to the app store, you decide when to enable identity verification. Typically, after you publish your identity verification enabled app version on the App Store you would monitor how many users have upgraded to this new version and only once you reach a high level of adoption would you enforce identity verification for your app.

Please note that identity verification needs to be activated and configured separately for your
test version
and production Intercom apps.

Getting the API Secret

Get the API Secret from your app settings (select 'Identify Verification' under 'Messenger' in the installation menu on the left-hand side of your screen), then select 'Identify Verification for Android'. To get your identity verification secret key just switch the setup identity verification toggle on to 'Enabled.' and store it in a secure place on your app server.

Warning for users who have already published a mobile app using the Android integration without identity verification:
selecting in this dialog means that from now on the API server will reject all requests that are not verified - effectively cutting off your existing apps until they support identity verification. Remember, after testing, you can always turn off this option and unverified requests will be allowed again.

Suppose the
observational study
described earlier was carried out, and researchers determined that the percentage succeeding with the combination drug/therapy method was highest, while the percentage succeeding with neither therapy nor drugs was lowest. In other words, suppose there is clear evidence of an association between method used and success rate. Could they then conclude that the combination drug/therapy method causes success more than using neither therapy nor a drug?

observational study

It is at precisely this point that we confront the underlying weakness of most observational studies: some members of the sample have opted for certain values of the explanatory variable (method of quitting), while others have opted for other values. It could be that those individuals may be different in additional ways that would also play a role in the response of interest.

For instance, suppose women are more likely to choose certain methods to quit, and suppose women in general tend to quit more successfully than men. The data would make it appear that the method itself was responsible for success, whereas in truth it may just be that being female is the reason for success.

We can express this scenario in terms of the key variables involved. In addition to the explanatory variable (method) and the response variable (success or failure), a third,
lurking
variable (gender) is tied in (or
confounded
) with the explanatory variable’s values, and may itself cause the response to be a success or failure. The following diagram illustrates this situation.

lurking
confounded

Since the difficulty arises because of the lurking variable’s values being tied in with those of the explanatory variable, one way to attempt to unravel the true nature of the relationship between explanatory and response variables is to separate out the effects of the lurking variable. In general, we
control
for the effects of a lurking variable by separately studying groups that are defined by this variable.

control

We could control for the lurking variable “gender” by
studying women and men separately
. Then, if both women and men who chose one method have higher success rates than those opting for another method, we would be closer to producing evidence of causation.

The diagram above demonstrates how straightforward it is to control for the lurking variable gender.

Systematic evaluation of complications with robust referral mechanisms to specialist services is required. The coordination of services at a local level aids this process. Provision of medical management of diabetes, patient education, and detection of complications via, for example, screening for DR at a single time and place in the community improve access to care. In resource-poor settings patients may travel long distances to attend health services incurring transport costs and loss of income. The involvement of government agencies is key to long-term service development. Outside funding and expertise may be vital in setting up health systems. However, sustainability and large-scale roll out of services necessitates national policies. Patient organizations are important advocates for services and can help create political momentum.

The effectiveness of laser photocoagulation at reducing the likelihood of VI and blindness in patients with PDR [
13
] and macular edema [
14
] is well established. Recent evidence demonstrates better outcomes in the short-term from intra-vitreal anti-VEGF agents (injected intra-ocularly) in diabetic maculopathy that has already reduced vision [
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]. This topic is the subject of a recent Cochrane review [
45
]. These agents, which require multiple repeat injections, will be increasingly used in resource-rich economies although with a continued role for laser. At present these agents are prohibitively expensive for widespread use in resource-poor countries (approximately US$800 per injection for the drug alone). However, off-label use of the systemic anti-VEGF, bevacizumab (Avastin) (approximately US$70 per injection), is used in some African tertiary centers on a paying patient basis, an approach supported by the BOLT study [
46
]. Vitreoretinal surgery has an important role in managing advanced disease. However, published data from this setting is sparse and more research on long-term outcomes and cost effectiveness is required.

Provision of laser services requires substantial initial investment in equipment and training of ophthalmologists. However, equipment upkeep costs are small and there are no on-going drug costs. The inadequacy of retinal training and paucity of referral networks are significant barriers to service development for DR. A number of proposals to confront these issues are listed below. Our clinical and research group has demonstrated that provision of a laser treatment service is feasible in SSA albeit with external support. In Queen Elizabeth Central Hospital, Blantyre, Malawi, set-up costs of equipment and training of ophthalmologists has been funded by an outside agency: the World Diabetes Foundation. OCOs have been trained in the recognition and referral of DR with funding from the same agency.

Increase the number of ophthalmologists trained and working in the region to allow increased sub-specialization

Provision of imaging and treatment infrastructure to allow sub-specialty practice

Creation of regional centers of excellence in Africa for provision of tertiary retinal care and training

Development of retinal research networks: providing funding both for personnel and equipment, facilitating income generation for eye units, setting standards for clinical practice, improving the evidence base for this setting, setting the political agenda and attracting excellent clinicians.

Prioritization of sub-specialty development in post-graduate training programs

Promotion of partnership arrangements with retinal centers in developed countries to facilitate knowledge and skill sharing

Provision of retinal fellowships tailored to developing world trainees in retinal centers in developed countries

Use of donor and government funds to minimize costs of such fellowships for trainees on condition of return to practice in country of origin

Various methods of screening for DR are available. Slit-lamp examination by a trained ophthalmologist and retinal photography with grading of retinopathy by accredited graders can be considered the reference standards for disease detection [
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]. Examination with the direct ophthalmoscope is less sensitive and specific for DR [
47
]. The cost effectiveness of DR screening has been excellently reviewed by Jones
et al
. [
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]. Systematic screening is cost-effective for sight years preserved compared with no screening. Variation in age of onset of diabetes, glycemic control, sensitivity of the screening test and compliance rates influence the cost-effectiveness of screening programs.